Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LP0816 | MN |
NPI | 1033401542 |
---|---|
Provider Name | Mary Lou Honstead |
First Address | New Brighton, MN 55112-2571 |
Second Address | New Brighton, MN 55112-2571 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2011 |
Last Update Date | 03/05/2011 |